New Congregant Form - Form - Congregation Shir Shalom of Westchester & Fairfield Counties, Inc.

Congregant Information

Shalom and welcome to Congregation Shir Shalom of Westchester and Fairfield Counties.
We are delighted you have chosen to become part of our community.

Please enter all applicable information in this form for our records and to help us communicate with you.

Note: Your responses will be maintained by the Shir Shalom Office and used for administrative and connection purposes. We do not disclose your information to third parties.

* First Name: Congregant A

Informal name if preferred:

* Last Name: Congregant A

Hebrew Name

* E-Mail Address: Congregant A

Cell Phone: Congregant A

Home Phone

Alternate Phone/Work

* Street Address

* City

* State

* Zip

Mailing Address if different than Home address:

* Birthday: Congregant A:

Occupation

Employer

City/Town where you grew up:

Marital Status:

If Married, please tell us Wedding Date:

Religious Background

If choose other, please specify religious background here:

Previous Synagogue Membership: If Yes, please list name(s) here:

Camps you attended:

College/Grad School Attended: (List schools here)

Are you a single adult family household? If yes, skip to Family Information Section

YesNo

First Name: Congregant B

Informal name Congr. B, if preferred:

Last Name: Congregant B

Hebrew Name

E-Mail Address: Congregant B

Cell Phone: Congregant B

Alternate Phone #

Birthday: Congregant B:

Religious Background

If choose other, please specify religious background here:

City/Town where you grew up:

Cong. B: Previous Synagogue Membership: If Yes, please list name(s) here:

Cong. B: Camps you attended:

Cong. B: College/Grad School Attended: (List schools here)

Occupation

Employer

FAMILY INFORMATION

Children or Dependents In Household Under 26 Years of Age

First Child: First Name

First Child Last Name

Gender

Birth Date

First Child: Hebrew Name

Second Child: First Name

Second Child Last Name

Gender

Birth Date

Second Child: Hebrew Name

Third Child: First Name

Third Child Last Name

Gender

Birth Date

Third Child: Hebrew Name

Fourth Child: First Name

Fourth Child Last Name

Gender

Birth Date

Fourth Child: Hebrew Name

Are you planning to or have you enrolled your child(ren) in our Early Childhood Center (ECC)?

NoYes

Are you planning to or have you enrolled your child(ren) in our B'Yachad Religious School?

NoYes

Adult Children Not Residing In Your Home

Names of Adult Children/Spouse

Names and ages of Grandchildren

Yahrzeit Observance

Please list the names of loved ones whose Yahrzeit you wish to have acknowledged during Shabbat worship services.

Please list the Name, Relationship to you and Date of Death. (Ex: Molly Rosen, mother of Sally, 1/1/2021)

If you do not have any Yahrzeit Observances, please skip below to Background Information section

Full Name

Relationship

Date of Death

Full Name

Relationship

Date of Death

Full Name

Relationship

Date of Death

Full Name

Relationship

Date of Death

Please list any additional Yahrzeit observances here: (Name, relationship, date of death)

Background Information

How did you hear about us?

(Ex: Family, friends, Website, social media, Print ad, live nearby, if referred by a congregant-please include name)

Why Have you Chosen to Affiliate with Shir Shalom: check all that apply

Connection to Jewish CommunityParticipate in adult learning and social programsHoliday ObservancesShabbat WorshipEnroll Children in ECC or B'Yachad Religious SchoolPrepare for Bar/Bat MitzvahSupport Jewish Presence in our community

Getting Involved

We are so happy that you have chosen to become part of OUR Shir Shalom community. A Shir Shalom congregant will call upon you to extend a personal welcome. We look forward to meeting you soon.

Committee Opportunities

Committees are what makes OUR SHIR SHALOM work. Yes, we have amazing clergy and professional and support staff but like all synagogues, OUR congregants are at the heart of our sacred community. Getting Involved is also a great way to make friends.

CONGREGANT A: Please answer questions below by checking all that apply:

Please list below any instruments played, sports that interest you or other interests not listed:

Language Skills: Do you read, speak and/or Chant Hebrew? Please indicate specifics

Language Skills: Do you speak any other languages? Please list here

CONGREGANT B: Please answer questions below by checking all that apply:

Please list below any instruments played, sports that interest you or other interests not listed:

Language Skills: Do you read, speak and/or Chant Hebrew? Please indicate specifics

Language Skills: Do you speak any other languages? Please list here

Do you give permission for your family's photographs to be shared in Temple Communications/Newsletters?

YesNo

Do you give permission for your contact information to be included in our Temple Directory? This information can only be seen by other congregants and CSS employees and clergy.

YesNo

Please use the space below for any questions/comments or to tell us anything else about your family that you think would be helpful:

Thank you for supporting Congregation Shir Shalom!